A retired U.S. government scientist, Shepter spent his final two years dwelling in a nursing home in Mountain Mesa, Calif., a small town northeast of Bakersfield. A stroke had paralyzed much of his body, while dementia had eroded his ability to communicate.

He died in January 2007 at age 76. On Shepter's death certificate, Dr. Hoshang Pormir, the nursing home's chief medical officer, explained that the cause was heart failure brought on by clogged arteries.

Shepter's family had no reason to doubt it. The local coroner never looked into the death. Shepter's body was interred in a local cemetery.

But a tip from a nursing-home staffer would later prompt state officials to re-examine the case and reach a very different conclusion.

When investigators reviewed Shepter's medical records, they determined that he had actually died of a combination of ailments often related to poor care, including an infected ulcer, pneumonia, dehydration and sepsis.

Investigators also concluded that Shepter's demise was hastened by the inappropriate administration of powerful antipsychotic drugs, which can have potentially lethal side effects for seniors.

Prosecutors in 2009 charged Pormir and two former colleagues with killing Shepter and two other elderly residents. They've pleaded not guilty. The criminal case is ongoing.

Health-care regulators have already taken action, severely restricting the doctor's medical license. The federal government has fined the home nearly $150,000.

Shepter's story illustrates a problem that extends far beyond a single California nursing home. ProPublica and PBS "Frontline" have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities. But for the intervention of whistleblowers, concerned relatives and others, the truth about these deaths might never have come to light.

For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices, which are responsible for probing sudden and unusual fatalities. We found that these agencies -- hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards -- have sometimes helped to send innocent people to prison and allowed killers to walk free.

When it comes to the elderly, the system errs by omission. If a senior like Shepter dies under suspicious circumstances, there's no guarantee anyone will ever investigate. Catherine Hawes, a Texas A&M health-policy researcher who has studied elder abuse for the U.S. Department of Justice, described the issue as "a hidden national scandal."

Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities. However, the limited evidence available points to a significant problem: When investigators in one jurisdiction comprehensively reviewed deaths of older people, they discovered scores of cases in which elders suffered mistreatment.

An array of systemic flaws has led to case after case being overlooked:

When treating physicians report that a death is natural, coroners and medical examiners almost never investigate. But doctors often get it wrong. In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.

In most states, doctors can fill out a death certificate without ever seeing the body. That explains how a Pennsylvania physician said her 83-year-old patient had died of natural causes when, in fact, he'd been beaten to death by an aide. The doctor never saw the 16-inch bruise that covered the man's left side.

Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.

Dr. Michael Dobersen, a forensic pathologist and the coroner for Arapahoe County, Colo., said he worries about suspicious deaths in nursing homes. "Sometimes, if I don't want to sleep at night, I think about all the cases that we miss," Dobersen said. "I'm afraid we're not looking very hard."

With the graying of the baby boom generation, such concerns will only grow in urgency. Within a few years, nearly one-third of all Americans will be over 60.

In a handful of locales, coroners and medical examiners have begun to view older Americans as a vulnerable population whose deaths require extra attention. Some counties have formed elder death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes.

But those efforts are the exception. In most places, little is being done to ensure that suspicious senior deaths are being investigated.

"We're where child abuse was 30 years ago," said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. "I think it's ageism -- I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old."

Checking the Wrong Box

There were two reasons that Joseph Shepter's passing initially triggered no scrutiny from authorities. He was in a doctor's care. And his physician classified the death as natural.

Across the country, state laws rely on doctors to separate extraordinary fatalities from routine ones, principally by what they record on death certificates.

When a doctor encounters an unusual fatality -- a death that may have been caused by homicide or suicide or accident -- the physician must report it to the coroner or medical examiner for further investigation. The investigative work can be as minimal as gathering clues from the place where a body was found, or as extensive as a full autopsy -- the dissection and evaluation of a corpse to pinpoint the precise reason for death.

In Shepter's case, Pormir, the nursing-home doctor, checked off a small box on the death certificate indicating that he never contacted the county coroner. There was no autopsy.

In reality, though, death certificates are frequently erroneous or incomplete, academic research has shown. A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them.

Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner.

In a 2008 study, 225 physicians were asked to determine what killed an elderly man who had fallen and suffered a severe head injury. Just over half of the doctors correctly identified bleeding of the brain as the primary cause of death. Nearly two-thirds didn't list the fall as a contributing factor.

"I knew people were going to get it wrong, but it was a surprise just how poorly people did," said Dr. Marian Betz, who led the study and teaches medicine at the University of Colorado.

Robert Anderson, chief of mortality statistics for the Centers for Disease Control and Prevention, said some doctors don't grasp the significance of death certificates.

"I've had instances where the physician just doesn't understand the importance of what they're writing down," said Anderson, who trains doctors in how to certify deaths. "I'm appalled when I hear that."

State officials in Washington and Maryland routinely check the veracity of death certificates, but most states rarely do so, Anderson said.

In Seattle, Dr. Richard Harruff has gone a step further. As the chief medical examiner for King County, Harruff launched a program in 2008 to double-check fatalities listed as natural on county death certificates. By 2010, the program had caught 347 serious misdiagnoses. Two cases were actually homicides. Two were suicides. More than 100 were accidental deaths due to falls or choking.

"If we want ensure that all death certificates are accurate, there has to be a professional, independent review process," said Harruff.

In Shepter's case, the death certificate deflected any investigation until an employee came forward with concerns about conditions at the nursing home, a public, 74-bed facility run by the Kern Valley Healthcare District.

The same month that Shepter died, a nurse told state officials that staffers were using potent antipsychotic drugs to "chemically restrain" residents with dementia, which can cause unruly and erratic behavior. Her complaint prompted the California Department of Public Health to cite the nursing home for unnecessarily doping 23 seniors and led to the federal fine.

It also spurred the California attorney general's office to open a criminal inquiry. Prosecutors asked Locatell, the elder abuse specialist, to evaluate the medical files of the nursing home's residents, including Shepter.

"I saw all kinds of indicators of neglect," said Locatell, noting that Shepter had lost almost 20 percent of his body weight over the span of three months. She said she was shocked by the "callousness of the staff towards this man."

In early 2009, prosecutors charged Pormir and two former co-workers with elder abuse that led to the deaths of Shepter and two additional residents, and with mistreating five others.

Kern Valley Healthcare District chief executive Timothy McGlew said he could not comment on the case except to say that his staff is cooperating with investigators.

The case has not yet gone to trial. Pormir and his co-defendants declined to comment.

For Shepter's son, the charges of criminal elder abuse came as a terrible surprise.

"I had no idea anything was wrong," said Joseph Shepter III, who goes by Joe. He and his sister have filed a civil lawsuit in Kern County Superior Court against the nursing home, Pormir and other staffers, alleging that they committed elder abuse and violated Shepter's rights. Pormir and the others have denied the allegations, court records show.

Joe Shepter used to think that his father "died a somewhat peaceful death" surrounded by caring professionals. Instead, he now believes, his "father was lying in a hospital bed essentially dying of thirst, unable to express himself -- so people could have a nice, quiet cup of tea."

Signing Off Without Seeing the Body

In many states, laws are so lax that doctors can sign off on death certificates without having seen a patient in months or actually viewing the body. As a result, even obvious signs of abuse have gone unnoticed by authorities in some instances.

Take the case of William Neff, a diminutive 83-year-old who passed away in an assisted-living facility in Bucks County, Pa. A World War II veteran, Neff suffered from advanced Alzheimer's disease, which had tangled the delicate fibers within his brain cells, limiting his speech.

After Neff died on Sept. 11, 2000, a doctor employed by the facility signed his death certificate, citing a "failure to thrive" due to "dementia" as the reason for his demise.

The physician, Anne Whalen, would later testify that she hadn't seen Neff for 13 days before his death. She wasn't at the assisted-living home when he died and never saw his corpse.

Still, it was perfectly legal in Pennsylvania for Whalen to decide how Neff had died and what should be written on the death certificate.

Neff's family arranged for his body to be transported to a funeral home to be prepared for burial. The moment the funeral home's director, Jeffrey Thompson, saw the corpse, he knew something was wrong.

"I'm no CSI expert, but I've been doing this for 25 years, and I've seen a lot of dead people," Thompson recalled. "He was all bruised up and purple, and his ribs were all broken." A bruise stretched from the man's left hip to the middle of his torso.

Thompson contacted the Bucks County Coroner's Office, urging staffers to perform an autopsy. The autopsy showed that some kind of violent impact had snapped five of Neff's ribs. One of the broken bones had pierced his left lung, flooding his chest with blood. The damage was fatal.

If Thompson hadn't spoken up, Neff's injuries probably would never have been detected.

"It could've fallen through the cracks," said Joseph Campbell, the Bucks County coroner.

The autopsy spurred county prosecutors and police to launch an 18-month criminal investigation, which eventually led them to Heidi Tenzer, an employee at the assisted-living facility.

Prosecutors accused Tenzer of stomping on Neff's chest, charging her with third-degree murder, neglect of a care-dependent person and aggravated assault. In 2003, a jury convicted Tenzer of the charges; three of her former colleagues were convicted of related offenses.

Whalen did not return calls from ProPublica and PBS "Frontline" seeking comment.

Zellis was astounded that a doctor could legally determine how Neff had died without actually seeing his body. "I was stunned," said the attorney, who is now in private practice. "To this day, I find it outrageous."

Ageism and Autopsies

Erroneous death certificates and faulty reporting practices are partially responsible for few senior deaths being investigated. But there's another factor: Many coroners and medical examiners resist looking into these cases.

Of the 1.8 million seniors who died in 2008, post-mortem exams were performed on just 2 percent. The rate is even lower -- less than 1 percent -- for elders who passed away in nursing homes or care facilities.

To a certain extent, the statistics reflect medically reasonable assumptions. The death of a young person is inherently unusual. By the time people reach their 60s, 70s and beyond, aging and disease have caught up to them, and death is more expected.

But Hawes, the Texas A&M professor who studies elder abuse, thinks the numbers also reflect bias. For a 2005 report to the Justice Department, Hawes interviewed 40 coroners and medical examiners about how they handle deaths among the elderly. In anonymous sessions, they voiced deep reluctance to autopsy seniors.

"Many of them made the blanket assumption that when an elderly person dies, it must have been because 'their time had come,'" she said. "But they don't make that assumption about any other part of the population."

In many jurisdictions, coroners and medical examiners are already struggling to autopsy the bodies coming into their morgues. Bringing in more seniors would further stretch their overtaxed resources.

"Coroners will say, 'We don't have enough money to autopsy every old person who dies,'" said Dr. Laura Mosqueda, a professor of geriatrics at the University of California, Irvine, and co-director of the Orange County Elder Abuse Forensic Center. The problem, she said, "is that coroners around the country are using the fact that they can't autopsy all older people who die as an excuse not to autopsy any older person who dies." She trains coroners and their investigators to zero in on signs of abuse and target their efforts strategically.

Some death investigators think concerns about elder abuse and neglect are overblown.

Dr. Jon Thogmartin, the chief medical examiner for Florida's Pasco and Pinellas counties, takes on more than 500 senior deaths per year, ordering full autopsies or checking bodies for external signs of injury. Thogmartin said "95 percent" of the elder abuse allegations he comes across "are completely false," and that many of the claims originate with personal injury attorneys.

But others in the field worry that some coroners and medical examiners may not be distinguishing fatal conditions caused by disease and aging from those caused by abuse and neglect.

When younger people wind up in the morgue, death investigators typically have a clear trail to follow. Was the person shot? Killed in a car crash? Beaten? Did he or she overdose on painkillers?

With seniors, however, they must hunt for more subtle clues. Harruff, the King County, Wash., medical examiner, teaches seminars about finding the forensic signs of elder abuse or neglect.

Some of his colleagues "don't take jurisdiction over neglect cases," Harruff said. "I take the attitude that these are potential homicides."

When Harruff scrutinizes an older person, he checks out the stomach to see if the person had eaten recently. He tests eyeball fluid to see if the person was getting enough to drink. Often, seniors who are neglected or abused are malnourished or dehydrated.

Harruff takes X-rays to search for broken bones, but he also looks for evidence of osteoporosis, which can cause bones to fracture easily without any sort of violence.

Harruff pays close attention to the body's hygiene and cleanliness, and takes note of what the person was wearing. He gets concerned when he finds a senior clad in filthy clothes who hasn't bathed recently.

It's never simple separating the damage done by natural processes from damage done by other people. "In an elderly individual, invariably there's a combination of processes -- if there's neglect, there's usually disease and neglect," he said.

Decubitus ulcers, better known as pressure sores or bed sores, are a possible indication of abuse or neglect. If a person remains in one position for too long, pressure on the skin can cause it to break down. Left untreated, the sores will expand, causing surrounding flesh to die and spreading infection throughout the body.

People with limited mobility are at greater risk of pressure sores. For patients in nursing homes, sores can mean that staffers aren't turning or moving them enough, a serious violation of accepted standards of care. Federal data show that more than 7 percent of long-term nursing-home residents have pressure ulcers.

The wounds can kill, notes Dr. James Lauridson, the retired chief medical examiner for the Alabama Department of Forensic Sciences. "Very often, that is the way these folks die," he said. "It is a preventable mechanism of death that we're missing."

Lauridson, who now performs autopsies for private clients, added, "Occasionally, there are elderly people who are being assaulted. But this issue of pressure ulcers is a far, far bigger issue, and really nationwide."

'I Don't Think We Understood the Level of Poor Care We Would Find'

There is a model for conducting elder death investigations effectively. It has taken root in Arkansas, thanks to the unyielding efforts of a man named Mark Malcolm.

In the late 1990s, while serving as the coroner of Pulaski County, which includes Little Rock and the surrounding area, Malcolm received a string of complaints about seniors dying in nursing homes under suspicious circumstances. He ordered the exhumation of six people, all of whom had supposedly died of natural causes.

The autopsy results were stunning: Four seniors had been killed by suffocation; two had died from medication errors.

Malcolm's experiences prompted him to push for a new state law requiring nursing homes to report all deaths, including those believed to be natural, to the local coroner. The law, enacted in 1999, authorizes coroners to probe all nursing-home deaths, and requires them to alert law enforcement and state regulators if they think maltreatment may have contributed to a death.

In the first four and a half years after the measure's passage, Malcolm reported 86 deaths to other authorities. The number represented a small fraction of the roughly 4,000 nursing-home deaths he and his staff investigated, but it was big enough to suggest there were widespread care problems.

"I don't think we understood the level of poor care that we would find. It came fast, it came furious," recalled Malcolm, who now runs a private disaster management consultancy.

After a death, Malcolm's investigators would visit the nursing home, taking photographs, reviewing medical records and looking for potential signs of poor care such as multiple pressure sores, undocumented injuries or unsanitary conditions.

They found such problems repeatedly at Riley's Oak Hill Manor North in North Little Rock.

Lela Burns remembers watching her mother, Irene Askew, rapidly deteriorate during the four and a half months she spent at Riley's in 2000. Admitted for rehabilitation after hip surgery, Askew soon developed ghastly pressure sores, including one that resulted in the amputation of her lower right leg. Askew died on Nov. 17, 2000. Malcolm ordered an autopsy, which concluded that another massive pressure sore had contributed to her death. The hole was the size of a fist and so deep it exposed bone on her lower back.

"It was a horrible place," said Burns. "You think to yourself, 'How could this happen?' It was just devastating."

The home came to a financial settlement with Askew's family, the terms of which are confidential.

The same year Askew died, another Riley's resident died with five pressure sores so severe they were deemed to be potentially life-threatening. Yet another died with 28 pressure sores. Riley's executives told the Arkansas Democrat-Gazette that they had done everything possible to meet government standards and had an explanation for every complaint. Malcolm's investigations led state regulators to shut down the facility, in part because of the home's failure to prevent and treat pressure sores.

A 2004 review of Malcolm's efforts by the U.S. Government Accountability Office concluded that the "serious, undetected care problems identified by the Pulaski County coroner are likely a national problem not limited to Arkansas."

Still, nursing homes inspections are not designed to identify problem deaths. The federal government relies on state death-reporting laws and local coroners and medical examiners to root out suspicious cases, said Thomas Hamilton, director of the Survey and Certification Group at the Centers for Medicare & Medicaid Services.

So far, other states have not followed Arkansas' lead. Its law remains the only one of its type in the country, according to experts who track legislation that affects elders.

Another Approach

While Malcolm focused on nursing homes, investigators in some communities are developing new strategies for pinpointing suspicious deaths that occur in private residences.

In 2007, Ingham County, Mich., formed an elder death review team made up of police, prosecutors, adult protective services, the medical examiner, emergency personnel and others to evaluate cases.

Across the country, several counties have created such panels, including King County in Washington, and San Bernardino, San Diego and Los Angeles counties in California. It's an idea borrowed from child-abuse investigators, who have established similar multidisciplinary teams to probe the deaths of young children.

Shortly after Ingham County's team began meeting, Margaret Robinson, 94, died at her home in Lansing, the county's largest city.

Robinson had been living with a man paid $220 a month by the state to care for her.

Since Robinson died at home rather than in a medical facility, a police officer paid a visit to the scene, as is customary in most places. Piles of clutter littered the home, and the place reeked of dog feces and cigarette smoke. Robinson's shriveled body, clad only in a T-shirt and an adult diaper, lay on a bed. The officer would later testify that he didn't spot "any type of foul play," so he called the medical examiner to collect the body.

That's when Connie McQuaid, an investigator with the medical examiner's office, got involved.

Fresh from a training session on how to detect elder abuse, McQuaid spent the night combing through Robinson's medical records.

She spotted "red flags" in the files, she recalled in an interview. Robinson's paid attendant, Ira Gudith, had failed to provide her with medication or diapers. Doctors had noted that Robinson looked "very thin" and emitted a "foul odor." McQuaid said she was bothered by "what appeared to be a lack of concern about her well-being. ... He was not attending to her daily needs."

McQuaid voiced her concerns to supervisors and police detectives. The medical examiner ordered an autopsy.

Forensic pathologist Brian Hunter found that Robinson was emaciated, weighing just 82 pounds, dehydrated and covered with pressure sores festering with staph and E. coli bacteria. Her brain displayed the signs of advanced Alzheimer's disease. These problems contributed to her death.

But the chief cause, Hunter said, "came as a surprise."

Tests of Robinson's blood showed lethal amounts of morphine. No doctor had prescribed it for her, and it seemed impossible that in her bed-ridden state Robinson could have gotten the drug herself.

Criminal charges quickly followed, and in October 2007, Gudith pleaded guilty to second-degree murder. He appealed the conviction and lost.

Gudith's lawyer, Paul Toman, said in an interview that his client had struggled to meet Robinson's mounting needs. "Ira's just a simple fellow," Toman said. "He was in way over his head."

For Ingham County, Gudith's arrest proved the value of its new approach.

"Without the elder death review team, this case would not have gotten the attention of the autopsy team. It would not have gotten the attention of the prosecutor's office," McQuaid said. "This man would have gotten away with murder."

This spring, PBS “Frontline” and ProPublica will explore how flaws in the American system of death investigation have left the elderly vulnerable to neglect, abuse and even murder and how a small cadre of innovators are working to bring such cases to light.

35 comments

This is one more example of the extreme pattern of the U.S. government protecting the crimes of businessmen and corporate leaders !!

The pattern includes :

(1) Murderous Drug Money Laundering and Bid Rigging Including Wachovia Bank Laundering $378 Billion, and Bank of America Laundering $3 Billion and No One Was Prosecuted !! NBC Links Prove A 12 year Old San Diego Boy Was Kidnapped and Forced To Decapitate Four People For the Cartels !! 40,000 Murders Have Occurred Since 2006 !! 35 Bodies Were Recently Dumped in Front of a Busy Mall !!

Four professors wrote profound quotes about this, including Professor Joseph Belth from Indiana University who wrote this about the U.S. Title 29 Erisa health care laws:

“They’ve turned Erisa on its head,” “It was supposed to protect employees, and it’s being used to protect insurers.”

WFAA - TV in Dallas wrote this about Workers Comp :

“a remarkable number of Texans committed suicide because they could no longer endure the pain caused by their injuries and they had been repeatedly turned down for worker’s comp care. Some insurance companies send peer review doctors medical files “stripped” of records important to the possible approval of workers’ comp claims.”

** During the time period of the suicides AIG rigged billions of dollars in bids to increase sales of Workers Comp policies; No one was prosecuted by the Bush administration !!!!

Identical crimes are also being committed against severely injured War Zone Contractors. This Spring I was contacted by an Iraq War Zone Contractor who had his leg, fingers and toes blown off in a car bomb blast. Here are exact quotes :

“The Sheriff repossessed my wheelchair because CNA Global Insurance stopped payment on the check that they issued to the suppliers and my life really started spiraling out of control”

“I am sleeping on the floor on a mattress in the living room with my Night care Assistant sitting on a chair next to my mattress. I have to use a bucket and a bottle to urinate in the evenings.”

Here are quotes from a ProPublica article :

“CNA’s failure to pay out benefits underscores the continuing problems with the Defense Base Act, essentially the workers compensation system for overseas federal contractors.”

“Workers fought long battles for medical care, including such things as prosthetic devices and treatment for post-traumatic stress disorder. The Labor Department seldom took action to enforce the law. Labor officials can recommend cases for prosecution to the Justice Department–but have only done so once in the past two decades, according to Labor officials.”

Quotes from Numerous Federal Court Judges Prove Insurance Company Doctors’ ignore life threatening medical conditions including Brain lesions and Multiple Sclerosis, cardiac conditions of many patients, and a foot that a new mother broke in 5 places, and also endangering multiple psychological patients !!

The failure to properly investigate elder deaths is one more example of the extreme pattern of the U.S. government protecting the crimes that businessmen, the insurance and medical industry, and corporate leaders commit !!

This stuff isn’t restricted to long-term care facilities. I am full-time caretaker of my mother and part-time helping hand for a friend of the family. The glaringly obvious conclusion I’ve reached is that steadfast attention is needed in order to insure proper care of the elderly. Without the notion that someone is watching every step, the tendency—in some places it’s the nursing staff, in others it’s the doctors—is to drop the ball on good medical care.

Over the course of helping them both through several hospitalizations and terms in rehab, it has only been with extreme vigilance that some horror stories of neglect have been averted—improperly administered meds, being abandoned for hours in wheelchairs after tests, sugar-filled meals for diabetics, and on and on. Given that the article here mentions brain bleeds and falls, I’ll cite one example at St. Lukes hospital in New York City, ironically part of a hospital group with a great reputation for brain injury treatment.

My mother came into the St. Lukes’ Emergency with a bump the size of a golf ball, sustained in a hard fall. She had a brain bleed, and according to the (excellent) ER, they would have to determine whether the bleed was the result of a stroke or the fall.

Two days later, in the hospital proper, the resident called me with a prescribed treatment that I was pretty sure would kill my mother. I asked her whether there’s been a determination about the cause of the bleed. The doctor responded that my mother hadn’t fallen. When I referred her to the ER record, she told me that “we don’t look at that, we only look at what’s in front of us.” So I asked, then, how she’d missed the huge bump on my mother’s head. I also asked if she gone through the records from my mother’s previous hospitalizations which I’d supplied. No, they didn’t look at that either. It’s only luck that I, with no medical training, was able to put the pieces together myself, and demand that they read what was in front of them. Once they’ had, the doctors did indeed change their treatment. In case you think I’m just a crank, when I had the records from that hospitalization forwarded to a new neurologist, the doctor noted—without any prompting from me—that the medical record was shockingly thin and inaccurate.

At risk of being perceived as a pain in the neck, as a patient advocate, especially for the elderly, you have to keep your eye on every detail, and given the results of Pro Publica’s investigation, one can see what a big job that is.

Christopher Reeves died from sepsis because his family tried to treat his sepsis at home and when it became apparent that they did not have the capability of treating it there and by the time they got him to the hospital, it was too late. Charge his wife no, but it is important to have all of the facts!

For some , Illeagle organ donations can be motivation for exceptional circumstances.
“Methodical Homicde” when someone becomes more valuable dead than alive. Really suspect when relatives inquire about your will. Abuse of the system is rampant by proxies of the Power of Attorney. Sometimes real people get tricked and are not even aware until it becomes too late.
Another aspect is that some county coroners are incapable of adequite pathology,may be merely, occupying an elected position.
Realistic enough, often only the high profile or wealthier subjects are able to sustain the senior years.

Truly this subject is at the frontier of American Society! Pro Publica has its work cut out.

WhateverForever: Christopher Reeves may have died as a result of neglect, but you cannot charge his wife with murder, manslaugher,negligent homicide or any other crime because
as Jim Morrison, also deceased, would say if he could:

Let this be a lesson to the people reading this horror. Take steps to protect yourself, if you are ever placed in a nursing home, and cannot rely on family to keep an eye on you.

Set aside money to pay an independent investigator—preferably a trained nurse or other trained medical professional—to visit your or your loved one UNEXPECTEDLY. Don’t give the place a chance to clean up for the visit. Send copies of your agreement with the investigator to your lawyer and your doctor (if you have one),
and to the State authority that licenses the care facility.

View the Frontline investigation on coroners. How they are appointed, what they know, whom they are accountable to. CHILLING!!!

What do you know about the coroners in YOUR area? Not difficult to find out. Don’t wait for tragedy to strike; take proactive steps to protect yourself and/or your loved ones.

So now, where are the “Pro Life” people. They are so busy trying to save 2 day old fetuses but never mention the right to life for a senior. It makes me sick.

Not that Mr. Sheptor could look forward to a full life. He was impaired or he wouldn’t have been in the nursing home to begin with. But he suffered from neglect. Bad neglect. Bed sores are horribly painful, dehydration causes systems to shut down and is awful to suffer and on and on.

I was once the marketing director for a national chain of nursing homes out of Houston TX. The well known corporation that bought these homes for seniors eventually sold them off. They figured they would make a bundles on this business but then They came up against the state of CA and it’s laws protecting residents - although not enough inspectors to inspect. I saw some bad stuff. I cried some days and quit after only six months.

My job was to entice the grown children of rich elders to put their relatives in our carefully marketed presentations. Yes, the wall paper was just fine, the visiting rooms were posh, the entrance was posh and they even push the old, senile patients away from sight when prospective customers came to LOOK SEE. Yes they had long ago learned to cover the smell of urine but they had learned to take good care of their ‘residents’ - as if the residents came here for a little posh vacation. I felt like a whole and quit

I wish your excellent reporters would investigate how “head hunters” employed at nursing homes target seniors for things like “swallowing studies” which of course lead to surgeries to install feeding tubes. I had a nursing home try to have my relative de-clawed like a cat because they didn’t want to trim nails…. surgery of course was reccomended! I feel it is a medicaid/medicare milking scheme and doctors willingly participate. And lawyers get in on the act too by creating “guardianship groups”. I could go on and on. Please look into this, it is an outrage. Contractors are ruining healthcare.

This article exposes a significant failure of many public death investigation agencies across the country. Unfortunately, there are not enough qualified Forensic Pathologists to examine a significant proportion of elders who die under nonsuspicious circumstances. What can be done right away, however, is for local communities to more rigorously inspect and oversee care homes and nursing facilities to prevent abuse, neglect, and substandard care. But it takes government funding, so sources of revenue need to be dedicated toward this mission. Perhaps a “death tax” for the benefit of improving death investigation and inspecting care facilities could work to protect the public.

Thank you for printing this article. Our family had a similar experience. The Los Angeles PD called it a murder but due to political considerations refused to formally investigate. When corporations are protected by government agencies and law enforcement because of their heavy political contributions the citizens suffer. A medical murder is a grievous violation of the law. It is further insult to the victim and their family that try to get enforcement of the law when told quite bluntly that corporate funding to an agency or legislator is more important than any citizen in this state.

When elderly have vascular narrowing caused by atherosclerosis, sometimes even the best nursing care will result in bed sores. If the vascular flow is so low that there is death of the tissues from absence of blood flow, no amount of repositioning will repair the damage. If someone is concerned about the care given to a family member, they are best served complaining when the person is still alive. Getting the attention of a Coroner’s office on an apparently “natural” death is going to be difficult, even downright impossible in some jurisdictions. Only a qualified board-certified forensic pathologist should perform these autopsies and direct this type of death investigation, because it is often difficult to tell if the patient died with the bed sores or from them.
Dr. Judy Melinek
Forensic Pathologisthttp://www.pathologyexpert.com/drmelinek.htm

Wow, lot’s of awful, awful things here. My heart hurts for all of you, I simply can’t imagine such conditions!!-but please take note- not every nursing home is an awful nursing home, and not all caregivers are evil! I have worked in long-term care for over 25 years- I love my job, and I love my residents! Our home is clean, we have few to none when it comes to wounds (please also keep in mind, not every ulcer is preventable-there are many factors such as nutrition, certain medications, etc. that will make a resident much more likely to develop ulcers). We hold our staff to the highest standards. We have cameras throughout our building.
Also keep in mind, staffing in homes is a constant challenge. Being a caregiver is a low-paying, thankless kind of job. (at one time you could make more money flipping burgers than caring for our elderly- priorities anyone??) With all the new Medicare cuts, pharmacy companies who continue to overcharge facilities for services, insurance companies who won’t be regulated, our long-term facilities are in for a world of hurt- which will affect the loved ones we care for. Medicare cuts mean staffing cuts- there are no nurse/patient ratios here- meaning you may have one nurse for up to 50 residents. Scary? You bet it is!! Better staffing, better care, everyone wins. It is horrific to think there are homes out there that are like what I read above- and being vigilant is a must!!!

Your article exposes one method of hiding the hundreds of thousands of stealth euthanasias occurring in our nation. And yes, the number is easily that high.

As President of Hospice Patients Alliance, I have received calls from thousands of bereaved family members whose elderly and/or severely disabled loved ones have been hastened to their death.

Sometimes, it is through neglect and abuse, leading to decline and death. Other times, it is outright intended death, through medications that should rarely be given to the elderly, or through intended dehydration and outright overdoses of medication.

We do not need Perry Mason to understand that sometimes people want the estate now, rather than waiting for a family member to die. There are ways and ways of causing death, and also, there are many ways to hide malpractice in the hospital or negligence in the nursing home. With all the good it can do and has done for many, unfortunately, hospice can become the dumping ground and the “cleanup crew” to cover up what goes on elsewhere.

While I share your outrage at this story, I am confused by your accusation of Pro-Life supporters. Since when did it become their job to fix all of the murders in this country? I am a mother; I am pro-life. I will work my ass off to see that none of my relatives face these conditions, and will continue to visit friends in nursing home & care facilities, checking on their well-being.

Lets not just blame the caregivers. Healthcare and business do not mix. When a business is trying to make money, they will not put the needs of patients and people first. To provide actual staffing (good-competant care with proper patient to caregiver ratios) the facilities would not make money. It is rare to find any MD, RN, APN, PA, LPN or CNA who actively look to work in nursing homes.
Lastly, where are the families? Yes, nursing homes should assist in caring for loved ones, but families still need to visit, help feed, bath and show affection to their loved ones. When I worked briefly in a nursing home, this was lacking. Families think they did not have to do anything to help their loved ones because they were paying the facility to do everything.

All of America’s problems have three causes. In order of importance they are: 1) Money, 2) money, and 3) money.

I have had extended hospital stays twice in my life. Once for 4 weeks in the UK and once for almost 6 weeks in the US. The difference in the standard of care was notable. In the UK nurses would turn and then wash and lightly massage the pressure points of bedridden patients every couple of hours. My US experience (in what was, according to their advertising, a supposedly major quality organisation) was one of total disinterest. As I know from experience, bed sores are excrutiatingly painful. In the US, after repeated complaints, all the treatment I got for them was to be handed a tube of cream. You may read about my US experiences here: http://www.mayovictim.com.com

It’s worth pointing out that, in a lot of areas, the situation changes to an absurd degree if the patient was under “alternative care.” I don’t have any direct experience, but a doctor-administered overdose will likely be ignored, but take an herbal soup or get a chiropractic treatment or something, and apparently everybody touching you is guilty until proven innocent.

I know of two cases that’ve struck me as suspicious, plus a couple more that I’ve only read about, but wonder about, based on what I’ve read. But as someone who’s not related to the deceased and only knew one of them, superficially, what can I do? Shouldn’t there be a tip line or email address, where people could lay out their reasons for suspicion, and let an independent expert (with no possible conflict of interest) assess the evidence & take action (or not) from there?

The kindest thing a relative or close friend can do for an older person in a nursing home (with the person’s permission, of course!) is to remove his clothing and look for signs of redness or pressure sores. Often the person needs to be on a special bed or mattress, as well as being turned.
Unfortunately, nursing homes are often understaffed and lack adequate equipment to help turn and move helpless patients.

What an excellent, well-researched, well-written article, thank you A.C. and Chisun. This is a frightening, challenging problem. Who’d have thought two generations ago that today miilions (ten’s of millions?) of people 65-105 would be languishing in thousands of effectively indifferent and unmonitored nursing facilites throughout the nation, paid by social security or unquestioning family members cluesless to what may be going on behind the scenes. The complaints of an hysterical, hypocrondiacal patient with Alzheimers, if even articulated, are too easy to dismiss when “authorities” at the facility assure that the resident is getting the best of care. The potential for indifferent or cruel treatment, through criminal. abuse, to actual homocide, is horrendous. Even if say just 2% of patients suffer legally actionable mistreatment, the numbers are staggering. I am 71 years old and this scares the hell out of me.

Luckily I’ve retired to Mexico, can probably stay and die at home, with one or more Mexican lady caretakers seeing to my needs until I’m gone. Nurses and trained caretakers are affordable here and do care about their charges.Older people are respected and very-well treated here.

I always wonder when old people die, abused by their children or completely abandoned to literally rot at a nursing home, were these parents harsh and horribly physically abusive to their children years ago? Are the chickens coming home to roost? In a couple of cases of elder abuse that I know of personally, this was the case. Just a thought. We do tend to reap what we sow.

Prosecuting a physician for murder in these regards sets a dangerous precedent. Since we don’t know the specifics of this case or that of Christopher Reeves conjecture is wreckless as is this article. When such an adversarial environment exists, three things will happen. The scene will become more populated with lawyers. Physicians taking care of nursing home patient’s malpractice insurance will go even higher than it has already gone. The physician response will be to stop caring for nursing home patients especially when the threat of criminal prosecution exists. For many of you, that would be exactly what you would like as physicians are the villains and are responsibile for all forms of human suffering and death. Perhaps you feel that there are just a few bad apples. I guarantee you that eventually all you’ll have left are the rotten ones willing to put up with this abusive situation. It’s already happening. Enjoy…

Responding to Barbara Crowley: Re; where are the pro-life people when it comes to the elderly and disabled?

Barbara, you are right to be concerned!

Our nonprofit, Hospice Patients Alliance, is one of the few, if only, nonprofits working to protect the elderly and disabled at the end-of-life specifically. As many here have posted, these abuses are not uniquely occurring in nursing homes, or hospitals or hospices, they’re occurring throughout the health care system.

We have struggled for decades not only to get the media to cover these issues, but to get the pro-life organizations to give more than lip service to the issues of life at the point where patients are elderly or disabled.

And yes, there are very few pro-life organizations that do anything at all about the hastened deaths of the vulnerable elderly in health care settings. See my articles:

As you know, the main, most-recognized pro-life organization is the Nat’l Right to Life Committee. They have historically viewed hospice as the rightful alternative to euthanasia and/or assisted-suicide and have therefore aligned themselves with that industry, even though the hospice industry is more and more becoming a haven for euthanasia proponents. I explain that in my book, Stealth Euthanasia: Health Care Tyranny in America available for free online.

Since Nat’l Right to Life is not exposing these issues, their state affiliates are not. Therefore, I hold Nat’l Right to Life responsible for failing the public, failing to alert the public to these terrible problems at the end-of-life, or even not at the end-of-life, but the ending-of-life for the vulnerable elderly and disabled.

Ron, in your very helpful article you repeatedly used the term “pro-life”.
I want to encourage you and others NOT to use that term for this group. They are not “pro-life”; they are anti-abortion and anti-contraception.

If they were “pro-life” they would be working to provide pre- and post-natal care for children born into poverty. They would be advocating for health care and early childhood education for ALL
children, especially the disadvantaged. Instead, they think life begins at conception—and ends at birth. Their real motivation—based on their warped religious beliefs—is to control women’s bodies.

So please stop using their “spin” language for what they are NOT. Instead, consider using the terms “pro-choice” and “anti-choice” for the respective groups.

Vickie - like you, several of my friends had problems at a well-known nursing home. The facility managed to get the LAPD off the case of a highly unusual death. Doctors and other staff want to keep their jobs and will do whatever it takes to protect the facility. They cover for each other. The LAPD, the coroner and the DPH all are content to look the other way. Looking into corruption at the DPH goes hand in hand with what is happening to elders and should be part of this investigation. If we have information about deaths due to neglect or abuse, can we contact the authors of this article? Anon asked the question - what other recourse do we have?

If you look at my first comment you will see multiple links to business and government officials refusing to do their jobs, as you experienced regarding the well known nursing home.

The last link shows Quotes from Numerous Federal Court Judges That Prove Insurance Company Doctors’ Ignore life threatening medical conditions including Brain lesions and Multiple Sclerosis, cardiac conditions of many patients, and a foot that a new mother broke in 5 places, and also endangering multiple psychological patients !!
The Judges quotes can be seen at the following website :

(The Obama and Bush administration would not do anything to stop them even though the patients can die due to lack of money for medical treatment and living while waiting for a Court ruling)

Robin, if you believe a crime was committed (or is being committed) you could try your local D.A, your State Attorney General, and the U.S. Department of Justice. Please don’t be surprised if they do nothing.

The crime victim (and possibly surviving family members in case of death) can file under the Justice for all act of 2004 which can be seen at :

The Federal Court and Appeals Court is required to make those filings top priority.

Robin, I hope you will find success. The pattern of neglect and abuse will probably continue unless you are able to stop those responsible at the nursing home you mentioned. I continue to seek justice but I pray a lot because after seeing so many Local, State and Federal agencies consistently protecting organized criminals I believe God and prayer is by far the best hope we have.

I wish that more people were aware of the Long-Term Care Ombudsman Program authorized by the Older Americans’ Act. We are a group of passionate, dedicated, relentless advocates for the rights of residents of long-term care. We are unbiased. We do not work for the State or for the nursing home. We believe that “Quality of care is essential; quality of life is critical.” We stand by and for the resident; often alone; often opposed. But for our Certified Volunteers, our program would be stretched thinner than cheesecloth. (I am responsible to 2000 residents, and I have a small service area comparatively.) My Certified Volunteer Ombudsmen visit their facility a few times a week and report suspicious activity or resident concerns to me for investigation. All states run their Ombudsman Program a bit differently; however Arkansas State Ombudsman Kathie Gately has revitalized our program and we are over 500 Ombudsmen strong. With every new volunteer we are 1 step closer to changing the face of nursing homes in Arkansas. SO CONTACT YOUR LOCAL AREA AGENCY ON AGING AND FIND YOUR OMBUDSMAN!! Or contact me and I will happily assist in any way possible. .(JavaScript must be enabled to view this email address) or 800-467-2171

From a retired pathologist’s point of view, there are several other issues. The first is that trained forensic pathologists are few in number, and many jurisdictions are served by elected coroners—who may vary substantially in interest and skill (I have known double-dipping coroners who were tow truck operators, morticians, and funeral home owners). Moreover, the coroner’s physician may be trained in any number of specialties other than pathology or have no technical resources to fall back on.

Secondly, there are numerous literature editorial, as well as many studies, regarding the ever-decreasing autopsy rate. While there are certainly philosophical reasons for this, underfunding of the medical examiner system, except after events such as 9/11, is embarrassingly common, particularly when funded locally with the usual competing budgets at city and county level. On top of this, the autopsy has, to the best of my knowledge, never been funded as a medical service per se. The deceased is no longer covered by health insurance, so an autopsy, to include technical, professional and toxicology aspects, is reimbursed minimally and indirectly through the Medicare hospital part A system, making it less a priority than the care of live patients.

Finally, there is a philosophical as well as religious and physiologic finality to human death in hospital. Whether it be a family’s discomfort at having the autopsy procedure performed, the interruption of a pathologist’s other intensive, and remunerative, activities, or a leeriness on the part of the hospital and attending physician to wake the proverbial sleeping dog of quality of care, autopsies can seem like an anachronism in the age of CT scans, MRI’s, genetics-based testing, and a misguided perception of the omnipotence of personal, medical care.

recently a lawyer visited a dying patient at a hospital. lawyer had patient sign away house. next day the incoherent patient died. Case manager says that happens all the time and they are told not to report it. Adult protection agents do not protect rights of patients in Florida.

The elderly face very great dangers in hospitals and nursing homes! .It is a national disgrace with no feasible solutions because “health care” is a “for-profit” industry that consumes a sizable portion of the GNP and produces great profit for the private- sector suppliers and the private- sector insurers. It is a “political” nightmare and neither political party tells the truth for fear of not being reelected. .

Try to understand that when Medicare introduced Hospice and Palliative Care many years ago, this was intended to be the fiscal solution to the great and growing expense to Medicare and the private insurers of the growing elderly population who were dying in the ICUs of the United States’ Acute Care Hospitals at great expense to Medicare and the private insurers. .

The 1991 Patient Self Determination Act was passed by the Congress with the view that the many or most of the elderly on Medicare would volunteer to die sooner rather than later with Advanced Directives that would reject life-saving and life extending procedures at the end of their lives.

Unfortunately, not enough of the elderly are volunteering to die earlier rather than later and public policy in the form of “reimbursement protocol” based on a “value based purchasing program” passed into law is incentivizing the hospitals to send elderly patients off sooner rather than later because they aren’t reimbursed for ICU time for elderly patients who haven’t authorized DNRs with advanced directives.

The promise of comfort care and drugs to ease the pain of dying is the promise of Hospice but, of course, Hospice is elective and elderly patients can’t be forced to give up their rights under the law to “full code” coverage in the hospital. Hospice is delivered in residential nursing homes and is sometimest a subsidy for the for-profit nursing homes who have to approve the for-profit and/or not-for-profit hospice providers who visit their residents. . .

Hospice is delivered in private homes with the help of volunteer “primary care givers” who are assisted by Hospice personnel, i.e. RN, LPN, Bath Aides, etc.. Physicians generally do not visit the private homes of Hospice Patients because this would make Hospice too expensive. They do, however, prescribe the drugs that ensure the promise of Hospice of a more peaceful and painless death. (Read Ron Panzer on this) . .

It is not known whether Hospice has really reduced the end-of-life expenses of the elderly to the degree that was anticipated and HOSPICE is a growing “for-profit” industry today that. as Ron Panzer indicates, is sometimes a “dumping ground” . or a “killing field” for those who abuse government programs for profit.

This, of course, is an UNINTENDED consequence of Admistrative Law that is intended to tame the costs of dying of the growing elderly population.

As Ron Panzer has indicated, “stealth euthanasia” of the elderly is an ugly reality that is hidden under the radar.

The elderly are sent, whenever possible, and before three days and nights in the hospital, to their own residences or to Nursing Homes to die when they elect “NO CPR” which then gives hospitals the legal right to keep them out of ICUs. If there are signs that an elderly patient may die in an ICU (if they even get there) they are removed from ICU in order for the hospital not to be subjected to the reimbursement penalties under the Value-Based Purchasing Program.

Something is terribly wrong! Who protects the elderly patients from the unintended consequences of well-intended policies? Unauthorized and secret DNRs and over-sedating is against the law but the law that is supposed to protect the patients is circumvented. . .

No one really tries to protect the Elderly except their families and friends. The laws in place covering the hospice program or for that matter most Federally funded senior related or long term related programs laws seem to only be for people that follow the laws and not for those that realize they can get away with breaking them.

A corporation striving for greater profit and an employee or employees wanting a bonus for assisting a corporation in obtaining its goals know that all that will happen, if they are caught, is that they will be asked to return to the Federal Government the Medicare money that was originally paid for the patient to be cared for. The patient is dead so the corporation comes out ahead anyway. Because the patient is dead Medicare comes out ahead as well. They don’t have to pay for that patient’s care any longer.

It is in the Federal governments fiscal interest to not look for wrong doing. If a citizen presents information that wrong doing has taken place then Medicare will act, but again, they only will request that the money be returned to the government. That is all they care about at the Federal level. While at the Federal level they are in general sympathetic and courteous to the survivors it does not mean that anyone will act to actually stop the corporation from repeating their criminal actions. The patient is dead and nothing will bring them back.

The Federal Government may hold Congressional Hearings about this but then they have done that already and for over 16 years. They didn’t act then. They ignored.

It sure looks as if the Federal level is working with the corporate level to allow these things to continue.

At the state level you have to wonder what is wrong. Corporations contribute heavily to state legislators and agencies, including District Attorneys. It does not appear to be in State agencies interests to bite the hand that feeds them. If by now people can’t see that some kind of agenda is taking place and it is not many, many, many accidents taking place, then there isn’t much that can be done to stop it. That agenda to me looks like someone is trying to save some money and they don’t care who gets hurt. I have to wonder if people would care enough to act on this fiscal saving if the abuse and deaths pertained only to those that received knee surgeries, or perhaps those that broke bones. Instead the government focus is on those that will be expected to eventually die. That simple statement seems to grant every wrong doer permission to abuse and kill patients. They were going to die anyway is repeated by these government agencies, over and over and over as an excuse to not investigate, to not enforce the law, to allow wrongdoers to continue their actions.

Everyone can see that there is a problem and certainly the reporting on this topic has been well done. When will a solution be found? When will government start enforcing the law? If you look at a larger picture, this has been going on for at least two generations. Soon it will be three. Soon it will simply be an accepted way of life in this country and I think that is what the wrongdoers and fiscal savers are counting on.

A year-long investigation into the nation’s 2,300 coroner and medical examiner offices uncovered a deeply dysfunctional system that quite literally buries its mistakes.

The Story So Far

In TV crime dramas and detective novels, every suspicious death is investigated by a highly trained medical professional, equipped with sophisticated 21st century technology.

The reality in America’s morgues is quite different. ProPublica, in collaboration with PBS “Frontline” and NPR, took an in-depth look at the nation’s 2,300 coroner and medical examiner offices and found a deeply dysfunctional system that quite literally buries its mistakes.

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